The aim of this study is twofold.Project 1: to determine in what percentage of patients, who have visited the emergency room for an asthma exacerbation, follow-up is scheduled, at what time and with which healthcare provider, what patient…
ID
Source
Brief title
Condition
- Bronchial disorders (excl neoplasms)
Synonym
Research involving
Sponsors and support
Intervention
- Other intervention
N.a.
Outcome measures
Primary outcome
<ul><li>Do patients with follow-up occurring <12 weeks after an asthma exacerbation requiring an SEH visit have less uncontrolled asthma in the year after SEH visit?</li><li>Is (the change in) asthma medication use before and after an SEH visit due to an exacerbation related to OCS use in the following year? This is analysed for both the total patient group and divided into subgroups with high OCS use and no/low OCS use.</li></ul>
Secondary outcome
<p>Descriptive medication use before and after ER visit</p>
Background summary
Asthma is a heterogeneous, inflammatory airway disease characterised by symptoms of coughing, wheezing and shortness of breath. These symptoms are caused by variable airway obstruction, airway hyperreactivity and hypersecretion of mucus in the airways. Most patients with asthma are adequately treated with inhaled medication. However, a proportion of patients with asthma have asthma exacerbations, which is defined as a sudden worsening of symptoms such as shortness of breath, wheezing and coughing. This sometimes requires emergency room visits. These asthma exacerbations occur regularly and should be considered a ‘red flag’: it is a clear signal that the asthma is inadequately controlled. Often, high doses of systemic corticosteroids (OCS), such as prednisolone, are needed to treat an asthma exacerbation. Prednisolone is usually very effective in treating an exacerbation, but at the same time it has serious long-term side effects such as depression, osteoporosis and type 2 diabetes mellitus. These side effects can occur as early as a cumulative exposure of 2-4 courses of prednisolone in a lifetime. Preventing an exacerbation, and thus prednisolone use, is therefore essential.
In an exacerbation requiring an emergency room visit, guidelines recommend scheduling follow-up within 1 week to prevent exacerbation worsening. In practice, this follow-up seems to take place infrequently. In addition, in uncontrolled asthma, which is an exacerbation par excellence, follow-up after 6-12 weeks is recommended to optimise asthma control and prevent future exacerbations. However, it is unclear if, when, and with whom this follow-up takes place and what factors are associated with healthcare utilisation in the year after the exacerbation.
Early identification and optimisation of patients with uncontrolled asthma is crucial for improving asthma care and preventing long-term effects of cumulative systemic corticosteroids.
Study objective
The aim of this study is twofold.
Project 1: to determine in what percentage of patients, who have visited the emergency room for an asthma exacerbation, follow-up is scheduled, at what time and with which healthcare provider, what patient characteristics are associated with having a follow-up appointment, and whether follow-up is associated with better asthma control in the year after the exacerbation.
Project 2: By using pharmacoepidemiological data, investigate how many patients have a high use of oral corticosteroids (OCS) after an emergency room visit with an asthma exacerbation, what patient and asthma medication characteristics are associated with this, and how, in particular, the use of inhaled corticosteroids (ICS) and OCS in the year prior to the exacerbation, as well as changes in ICS use in the year after, influence this.
Study design
Restrospective, observational cohort study
Intervention
N/A
Study burden and risks
N/A
M van der Ploeg
Henri Dunantweg 2
Leeuwarden 8934AD
Netherlands
(058) 286 3185
michelle.van.der.ploeg@frisiusmc.nl
M van der Ploeg
Henri Dunantweg 2
Leeuwarden 8934AD
Netherlands
(058) 286 3185
michelle.van.der.ploeg@frisiusmc.nl
Listed location countries
Age
Inclusion criteria
Patients who meet the inclusion criterion below will be included in the study:
Patients (18 years and older) who visited the emergency room of Frisius MC with an asthma exacerbation between May 1, 2022 and May 1, 2024.
Exclusion criteria
Patients who meet any of the exclusion criteria below will not be included in the study:
- The patient does not consent to participate in the study.
- The patient has an inflammatory comorbidity for which corticosteroids are used, to ensure that all OCS use is related to the treatment of asthma and thus avoid confounders.
Design
Recruitment
Medical products/devices used
IPD sharing statement
Plan description
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| Research portal | NL-009176 |